Provider Demographics
NPI:1356626360
Name:MALONE, LEANNE (LPN)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 GENESEE AVE NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4209
Mailing Address - Country:US
Mailing Address - Phone:330-720-9623
Mailing Address - Fax:
Practice Address - Street 1:871 GENESEE AVE NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-4209
Practice Address - Country:US
Practice Address - Phone:330-720-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122941164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse